Abstract
The objective of this paper is to review and summarize conclusions from the available literature regarding Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). The authors have independently reviewed articles from 1977 onwards, primarily focusing on the etiopathology, symptoms, differentiation between similar psychiatric conditions, immunological reactions, alterations in the nervous system and gut microbiota, genetics, and the available treatment for PANDAS. Recent research indicates that PANDAS patients show noticeable alterations within the structures of the central nervous system, including caudate, putamen, globus pallidus, and striatum, as well as bilateral and lentiform nuclei. Likewise, the presence of autoantibodies that interact with basal ganglia was observed in PANDAS patients. Several studies also suggest a relationship between the presence of obsessive-compulsive disorders like PANDAS and alterations to the gut microbiota. Further, genetic predispositions—including variations in the MBL gene and TNF-α—seem to be relevant regarding PANDAS syndrome. Even though the literature is still scarce, the authors have attempted to provide a thorough insight into the PANDAS syndrome, bearing in mind the diagnostic difficulties of this condition.
Highlights
Rheumatic fever is an acute autoimmune disease constituting a relatively late complication of GAS infection [12,13]
2%–4% of children with rheumatic fever are prone to developing Obsessive-compulsive disorders (OCD), which is associated with the progressive damage of basal ganglia [20,21]
Besides the alterations that were observable using Magnetic Resonance Imaging (MRI), the study with the usage of Positron Emission Tomography (PET) showed that PANDAS patients tend to present with a higher percentage of binding potential values in bilateral caudate and lentiform nuclei compared to the control group [148]
Summary
Acute pharyngitis and tonsillitis may be induced by various bacterial and viral organisms, even though β-hemolytic Streptococci group A remains the most common causation so far [1,2,3]. Streptococcus pyogenes (β-hemolytic Streptococcus group A) (GAS) is responsible for the majority of bacterial infections in children [4]. There are incidents of non-streptococcal infections by the Bornavirus or Mycoplasma pneumoniae that are implicated in the onset of symptoms similar to those in PANDAS [8,9,10]. Exacerbations of PANDAS symptoms are observed in 30% of cases due to GAS infections; 20% are because of non-streptococcal illnesses and approximately half of the cases are because of a non-identified factor [11]
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